مجله ایرانی اخلاق و تاریخ پزشکی
سال شانزدهم شماره 1 (بهار 1402)

Defensive medicine is performing actions that have no medical indication and benefit for the patient (positive defensive medicine) or refraining from performing risky actions that have a medical indication and benefit for the patient (negative defensive medicine). These actions are carried out by the physicians with the sole motive of protecting themselves against complaints or tensions such as the protest of the patient or colleagues and usually cause physical, psychological, or economic harm to the patient or the institution that pays the treatment fee, such as insurance organizations. It can have consequences in terms of the quality of care and the efficient use of limited health resources. Factors such as the physician’s concerns about lawsuits and proceedings may lead to defensive behaviors. This study presented suggestions for the management and prevention of such behaviors, including three main categories related to the strategies for the reformation of the patient complaint handling system, social strategies for the management and prevention of defensive medicine, and managerial-organizational strategies. These strategies are based on the findings of a mixed-methods research including an unsystematic review of resources and a qualitative study conducted using semi-structured interviews. The results have been discussed by the Medical Ethics Committee of the Academy of Medical Sciences of Iran.

Entrepreneurship and the creation of knowledge-based wealth during the past years are considerable issues in scientific and executive institutions, including health institutions. the present study aimed to design course topics to empower medical professionals to have an effective role in the innovation, technology, and knowledge-based ecosystem. This study was conducted using the scoping review method. After determining the research questions, a wide range of studies were investigated systematically and then a snowball search was performed to identify more relevant studies. In the next step, the most relevant data were extracted and then categorized and arranged according to the needs, and finally, the results were summarized as descriptive and inferential statistics tables. The data were coded and analyzed in pairs. Ultimately, the areas and course topics of the entrepreneurship curriculum were extracted and arranged as a suggested list. Then, the expert panel method was used to agree on the course topics and develop educational goals. In this study, 52 essential competencies were identified for medical professionals to have an effective role in the innovation, technology, and knowledge-based ecosystem. These competencies were categorized as 17 course topics and 3 categories including motivation, entrepreneurial knowledge and skills, and business knowledge and skills. Providing the necessary training to develop a comprehensive view of the opportunities and needs in society as well as the knowledge-based business environment is one of the basic concepts that should be included alongside entrepreneurship and business.

At first, education was the university’s only goal; nevertheless, scientific progress in the twentieth century added research to the universities’ missions. The industry sector’s knowledge-based technologies added a third mission to universities and brought the university into new fields. The fourth-generation universities provided a more comprehensive view by considering the four elements including university, industry, government, and civil society and the next generation (the fifth generation) of universities also considered the environment in addition to these four elements. The present study examined the optimal conditions and requirements for new-generation medical universities (third- to fifth-generation universities). This review study extracted 187 scientific documents from domestic and foreign databases and after screening, 56 documents were selected for the study. Finally, the propositions relevant to the objective of the study were extracted and categorized using content analysis. This study identified 17 optimal conditions for transitioning to new-generation universities. Moreover, 41 requirements were extracted and listed for achieving these conditions, each under its corresponding condition. New-generation universities are known as borderless and accountable universities. Thus, the communication and exchange of knowledge, capital, and value with institutions outside the university at the local, national, and international levels as well as accountability to the needs created at these levels are the main principles of new-generation universities. Given the unique structure of the Iranian health system and the infrastructure for communicating with society, by fulfilling other requirements, this structure can facilitate the transition to new-generation medical universities.

In summary, this project was carried out in the following steps: reviewing the literature, determining the ethical and legal aspects of the implementation of the electronic health records, reviewing the existing laws and regulations in Iran, identifying the shortcomings and localizing the ethical and legal aspects of implementing electronic health records in Iran, and providing operational suggestions. By reviewing the literature, a list of ethical aspects of electronic health records was extracted and analyzed. Moreover, through reviewing the laws and regulations, it was shown that in the last decade, numerous and diverse laws have been passed in the field of electronic health, especially regarding electronic health records, and there is no serious legal gap in this field in the country. However, certain serious problems were observed including non-implementation or incomplete implementation of some existing laws and regulations, lack of sufficient technical and executive regulations and determining the examples of deviation from the goals of the laws and regulations or their correct implementation, and lack of implementation guarantee for some laws and regulations. Based on the studied documents, the current state of electronic health records in Iran was investigated from legal and ethical aspects, and operational suggestions were presented for its reformation and promotion.

To enhance the level of health literacy among the public, it is essential to take steps towards empowering people to recognize and control the influential factors on health. University professors, as health knowledge promoters, are recognized as educators of health skills and advocates for healthy lifestyles and behaviors. This study aimed to elucidate the role of medical professors in promoting the health literacy of the public. The present study was conducted using conventional content analysis. The participants were selected using purposive sampling with maximum variation. A total of 20 professors from medical universities, the Academic Center for Education, Culture and Research, and the Ministry of Health were purposively selected until information saturation. Data were collected through semi-structured interviews and analyzed simultaneously with data collection. Twenty participants (9 females and 11 males) with an average age of 50.3 and an average work experience of 23.45 years took part in the study. After data analysis, 947 initial codes were extracted, and subsequently, categorized into five main categories and fifteen subcategories. Infrastructure development, content production, role model, self-empowerment, and culture building were identified as the main categories. University professors can, through a skillful combination of various elements within the educational system, either propel students and the general public towards lofty goals or deprive them of achieving such objectives. However, factors such as the low number of professors relative to the number of students, the high workload of faculty members, lack of resources, and the overwhelming life responsibilities of faculty members have influenced their performance and role in this regard. To achieve the goal of encouraging professors in enhancing the health literacy of society, it is imperative to bring these constraints to the attention of authorities for resolution.

General courses can effectively empower students and enhance their professional and social personality, and it is essential to continuously evaluate the effectiveness, status, and updating of these courses. Accordingly, the present study aimed to investigate the factors influencing the effectiveness of teaching general courses in the medical curriculum in Iran. The study involved both qualitative and quantitative phases. After conducting semi-structured interviews with experts, medical students, and professors of general courses, and using Braun and Clarke’s thematic analysis method, 528 codes were extracted and classified into 4 themes, 11 categories, and 33 subcategories. The main themes included updating the curriculum, focusing on effective and purposeful learning, collaboration and needs assessment of the stakeholders, and linking general courses with practical skills. Based on the results of the qualitative phase, a model for the effective teaching of general courses was developed using Delphi method with subject matter experts, and the validity of the model was confirmed with a two-round validation process. Removing unnecessary courses or those with repetitive content, designing needs-oriented content, involving experts in course revisions, using skill-based education methods, increasing skill-based and practical courses, flexibility in evaluation, and utilizing new educational technologies indicated the highest mean and consensus index. The results showed the necessity of evolving the traditional education system, rethinking, revising the topics and content, focusing on skills based on new needs, promoting evaluation models, and utilizing modern tools and technologies in teaching general courses.

The higher health education system in the Islamic Republic of Iran is an integrated system with multiple stakeholders responsible for training human resources in the health sector at different levels. The Academy of Medical Sciences of the Islamic Republic of Iran is one of the effective institutional factors in this system. This study aimed to explain the position of the Academy of Medical Sciences in the country’s medical sciences education system and outline its major directions in this field. In this study, the knowledge-to-action framework was implemented in four steps. Effective institutional factors in system development were explained, and the role of the various stakeholders of the country’s medical sciences education system was compared with them. Then, the functions of the academy as a main beneficiary based on the degree of connection with the stages of the knowledge-to-action framework were weighted, and finally, these functions were classified into different categories. According to this model, although the academy plays a role in many stages of the development of the country’s medical sciences education system, it primarily functions as a think tank and observatory and to a lesser extent as a knowledge implementation unit. The model presented in this study will help the trustees of the Academy of Medical Sciences to play the largest and most effective role in the development of the country’s medical sciences education system, with optimal resource management and principled development of human capacities, thereby laying the groundwork for the improvement of the integrated health system.

The right to access health services as a part of fundamental human rights, affected by the conditions and facilities of governments and the international status, has always faced challenges. Despite the clarity of the general policies and upstream documents in the Iranian health system regarding the need to provide immigrants and refugees with health services and Iran’s membership in the relevant conventions, the implementation of the provisions of these documents is not consistent and complete for various reasons, including the inadequacy of laws related to immigrants and refugees and the incorrect implementation of some existing laws. The first draft of the ethical guidelines for providing health services to immigrants was prepared by the research team using the results of a review of relevant documents as well as a qualitative study and finalized according to the opinions of the participants in a panel of experts. In this draft, after explaining the values and ethical principles governing the provision of services to Afghan immigrants, the suggested guidelines and assignments were presented to the main stakeholders involved, including the policymakers and macro planners of the health system, institutions and centers providing health services, professionals and health service providers, professional organizations, civil society activists, media and non-governmental organizations,  and medical research and education authorities and researchers.

Academic faculty members play the most influential role in realizing the goals and ideals of higher education and community health. In the contemporary period, the cultural and educational role of professors, in the most crucial mission of higher education, has not received the required and necessary attention, and neglecting it has resulted in irreparable damages and adverse consequences. This study attempted to identify the prominent cultural roles of professors in relation to students (with an emphasis on higher health education), while explaining the necessity and importance, and effective solutions were examined and proposed. The present study was conducted using a descriptive-analytical method and a focus group discussion. Selected views of expert professors and data from authentic local scientific articles and related topics in upstream documents were utilized. The findings of the study were classified into five main themes and forty categories. “Cultural goals and ideals”; “general mission of professors for the cultural education of all students” and “special mission of professors of higher health education”; “authentic methods”; and “requirements for cultural education of students” were identified and recommended under the eight selected topics in each axis in order of priority. University Professors play a central role in the cultural and ideological education of students. It is appropriate to develop this responsibility in an objective manner and with suitable scientific methods and observe its excellence and realization in the education system.

The COVID-19 pandemic has created opportunities and challenges for education and research as the two main academic activities in medical sciences disciplines, which due to their mutual influence can be used to propose solutions for improving these two areas. The present study was conducted to compare two review articles, each of which dealt with one of these two areas.This comparative study with a qualitative explanatory design was conducted in three steps. First, two review articles were selected that investigated the opportunities and challenges caused by the coronavirus pandemic to propose strategies for the post-corona era. Then, both studies were carefully studied and described. Finally, two researchers separately extracted the similarities and differences mentioned in the two articles and compared them to remove the inconsistencies. A panel of experts confirmed the findings. The opportunities and challenges mentioned in the two articles were extracted and categorized into two areas based on similarities and differences. The similar proposed strategies for the post-corona era were continuing to use virtual space facilities, diversifying the communication methods with students and research participants, and providing and developing suitable electronic infrastructure. Comparing two review articles and determining the similarities and differences between the opportunities and challenges caused by the COVID-19 pandemic and the strategies for the post-COVID-19 era related to medical education and clinical research, led to proposing strategies that could promote these two related areas coherently.